Why Not Us? Time For Better -- No, Basic -- Customer Service In Medicine

It’s informative to step away every now and then from the glittery world of optimistic J-curves and elegant digital dreams, and remember how ordinary medicine is still practiced.

Let’s take as a prismatic example the most routine, least dramatic problem imaginable: I wanted to get a flu vaccination for my kids.

As a digital health enthusiastic, and believer in cost-effective care where possible, I figured I’d use the web-based HealthMap Flu Vaccine Finder to find a local pharmacy where I could get their vaccine.

The application – originally built by Google, and now run by the non-profit HealthMap – seemed ideal: you enter your zip code, the type of vaccine you want (the nasal spray, in our case), and presto, a Google Map shows up with the locations of pharmacies offering the specific product, together with contact information.

Reaching a pharmacist at the local Walgreens proved problematic, and when I finally got through, I learned that not only were the kids too young for the program (they needed to get it from a pediatrician), the pharmacy didn’t carry the nasal spray, and in fact never did.

Next, I tried calling (no email access available) the office of our kids’ pediatrician, to ask if there was a time I could bring the kids by the office, where a nurse might administer the vaccine – the same way many of us get vaccinated each year at work.

Although the pediatrician’s office was open, the call was routed to a third party, who didn’t know anything about the practice itself, but dutifully copied down all my info, and passed it along.

The office called me back about ten minutes later; I repeated my story, and was told that walk-in vaccinations were not offered – a regular office visit was required.

This seemed unnecessary: we needed two quick vaccinations, not two complete office visits – not to mention the inevitable delay (about 45’ the last time), in a sparse waiting room filled with coughing kids and old Highlights, spent counting the minutes until you’re ready to be seen. (Goofus waits his turn patiently; Gallant wonders if there’s a better way.)

Eventually, I reached out to our kids’ previous pediatrician, and finally secured two five-minute slots for the office nurse to administer the vaccine. This experience – so utterly ordinary and undistinguished in every way –nevertheless offers a few lessons:

Don’t confuse eHealth with health. The HealthMap application, for example, seems like a great idea, a perfect blend of tech, consumer, and health. At first blush, it looked terrific. However (at least in my case), it didn’t actually provide accurate, current information. I’d be reluctant to use it again– an important lesson for developers of web-based health information portals to keep in mind. This is also why a health application such as UpToDate is so popular and has endured for so long: it’s carefully vetted and rigorously maintained, while many information aggregators are not.

Healthcare remains remarkably deficient in basic customer service. It is far easier for me to reach a person at my car repair shop, and to have a meaningful interaction, than it is for me to reach someone in my pediatrician’s office; and my mechanic is much easier to schedule – and far more likely to be ready for me on time. In contrast, I’m always reluctant to pick up the phone to call the doctor’s office, anticipating (usually correctly) that it’s destined to be the start of a painfully drawn-out interaction.

Doctors are hoarding services they shouldn’t. Your kid shouldn’t need a full office visit to obtain a flu shot, and there are a range of other services that truthfully don’t require a physician – exactly as Clay Christensen points out in The Innovator’s Prescription. Moreover, everybody’s realizes this – the challenge is getting physicians to relinquish turf, especially when they are feeling so many other pressures as well. Ultimately, the answer here has got to be for doctors to better define and vigorously pursue what they are uniquely qualified to do.

As a whole, this experience, and others like it, also piqued my interest in potentially finding a concierge practice for our family. To this point, I’ve viewed many of these doctors fairly skeptically, and assumed they were offering patients a sort of preposterously high-touch care that might contribute to a patient’s sense of self-importance, but wasn’t otherwise necessary.

Over the last few years, however, as I’ve struggled to reach a person and get basic information from a number of doctors’ offices – and worse, as I’ve avoided seeking routine care because I can’t stand the aggravation and the bureaucracy – I’ve started to ask whether there’s a better way.

If the “perks” of concierge care are a chance to easily reach a person in the office, easy email access, prompt, convenient scheduling of visits, and a physician with the time to talk to me – it’s hard to see how these benefits should be considered remarkable in any way. Table stakes, as we used to say in consulting.

The number of “ordinary” people pursuing concierge care suggests its appeal comes not from the extravagant expectations of patients, but rather from the basic level of service that most other industries have learned to deliver, and that most customers have learned to demand. Echoing the words of a great pitcher, many patients now want to know, “Why not us?”

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Had the same experience last week when I called the pediatrician’s office for a flu shot. Said I had to go to a pharmacy, which I didn’t want to do because my daughter is too young. She only got it because I later took her for a physical. Concierge outfits, such as One Medical, don’t have pediatricians. At least not yet.

Right on! Right on! Customer service is non-existant in healthcare. The idiots that defend our current system as ok need to be made to wait in the doctors office for the rest of us. There’s little good in our healthcare system, outside the people. I don’t care much for the idea to get decent service you have to pay extra. The insurance companies have the doctors running them in and running them out. I’m not sure what the allotted time is supposed to be, but my usual face time with the Doc was about 5 minutes at best after my hour and a half wait.

You mentioned Goofus and Gallant in your article. Let me introduce you to Impatient, who jumps in the middle of the Doctor and begins to scream at him and is asked to find another Physician. We parted ways in full agreement that I didn’t care for him and he didn’t care for me. When I get unhappy with a business I want the guy in charge because he’s responsible.

Agree. Too much hassle and worry in healthcare system currently. Patients at Kaiser Permanente can email their doctor and get flu shots in the doctor’s office, including pediatrics. http://mydoctor.kaiserpermanente.org/ncal/coldandflu/

The reason basic customer service is absent from healthcare delivery is because the most basic laws of economics are being violated everyday by the healthcare industry. It does not matter whether your doctor offers 5 star service since the rate he is paid for the hundreds of codes he bills are dictated by single person who barely attained a college degree called a contract negotiator who works for a health insurance company – not market forces. The solution is coming, my start-up and others are bringing customer service and competition to basic healthcare.

Here’s the major reason that customer service sucks in the doctor’s office. By law, we can charge only what medicare allows (or the contracted rate with private insurance), which is the same for all providers. That’s right, it’s price fixing—from the payer side, so there’s no reason to differentiate your service, since you’re paid the same no matter what. In fact, all of the incentives are to crank through as many patients as possible in as little time as possible (sound familiar ?).

By the way, under ObamaCare, get ready to wait in line a whole lot longer for your lousy service.